scholarly journals A minimalist technique for insertion of intrauterine devices

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Norman David Goldstuck
Keyword(s):  
Large Scale ◽  
Health Care Systems ◽  
Intrauterine Device ◽  
General Rule ◽  
Cost Effective ◽  
The United States ◽  
Efficacy Rate ◽  
Pelvic Infection ◽  
Care Systems ◽  
Long Acting

The world’s population is approaching 7 billion. As a general rule, the countries with the highest population have the least available healthcare resources, the most notable exception being the United States of America (USA). Most of these countries have an urgent need to reduce their populations. The intrauterine device (IUD) is used by the largest number of contraceptives world-wide and it has a proven record in reducing unwanted pregnancies. Its efficacy rate as a long-acting reversible contraceptive is matched only by subdermal implants which are not as cost effective. Although the rates of pelvic infection are elevated in many countries with low-resource health care systems, we now know that pelvic infection rates are independent of IUD usage. This is therefore no longer a contraindication for using IUDs on a large scale in family planning programs. The technique of IUD insertion as described in most textbooks and journals is unnecessarily complex and based on ritual rather than good clinical evidence. This is particularly interesting in that at a time where we prefer evidence based medicine there are still so many clinical practice sacred cows. This article advocates a simplification of the technique for inserting IUDs. The scientific rationale for simplifying the technique is presented, as well as evidence that it is as safe if not safer than the currently suggested methods, if used for the correct type of IUD acceptors.

scholarly journals Limited containment options of COVID-19 outbreak revealed by regional agent-based simulations for South Africa

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 98 ◽  
Author(s):  
Andreas Bossert ◽  
Moritz Kersting ◽  
Marc Timme ◽  
Malte Schröder ◽  
Azza Feki ◽  
...  
Keyword(s):  
South Africa ◽  
Large Scale ◽  
Health Care Systems ◽  
The United States ◽  
Global South ◽  
Agent Based ◽  
Global Pandemic ◽  
Agent Based Simulations ◽  
Care Systems ◽  
The One

Background: COVID-19 has spread from China across Europe and the United States and has become a global pandemic. In countries of the Global South, due to often weaker socioeconomic options and health care systems, effective local countermeasures remain debated.  Methods: We combine large-scale socioeconomic and traffic survey data with detailed agent-based simulations of local transportation to analyze COVID-19 spreading in a regional model for the Nelson Mandela Bay Municipality in South Africa under a range of countermeasure scenarios. Results: The simulations indicate that any realistic containment strategy, including those similar to the one ongoing in South Africa, may yield a manifold overload of available intensive care units. Only immediate and the most severe countermeasures, up to a complete lock-down that essentially inhibits all joint human activities, can contain the epidemic effectively.  Conclusions: As South Africa exhibits rather favorable conditions compared to many other countries of the Global South, our findings constitute rough conservative estimates and may support identifying strategies towards containing COVID-19 as well as any major future pandemics in these countries.

scholarly journals Availability and accessibility of monoclonal antibodies in Bosnia and Herzegovina: Findings and implications

2021 ◽  
Vol 5 ◽  
pp. 239920262110276
Author(s):  
Biljana Tubic ◽  
Vanda Marković-Peković ◽  
Saša Jungić ◽  
Eleonora Allocati ◽  
Brian Godman
Keyword(s):  
Monoclonal Antibodies ◽  
Insulin Glargine ◽  
Bosnia And Herzegovina ◽  
Inflammatory Diseases ◽  
Health Care Systems ◽  
The United States ◽  
Insulin Analogues ◽  
Significant Group ◽  
Care Systems ◽  
Long Acting

Background: Monoclonal antibodies (mAbs) represent the most numerous and significant group of biotherapeutics. While mAbs have undoubtedly improved treatment for many chronic diseases, including inflammatory diseases, they are typically expensive for health care systems and patients. Consequently, access to mAbs has been a problem for many patients especially among Central and Eastern European (CEE) countries. However, biosimilars can potentially help with costs, although there are concerns with their effectiveness and safety. This includes biosimilars for long-acting insulin analogues. Aim: Assess the availability and use of biological medicines, including biosimilars within Bosnia and Herzegovina (B&H). Methods: Assess the availability of mAbs via the current lists of approved and accessed mAbs versus those licenced in Europe and the United States and their utilisation, as well as specifically insulin glargine and its biosimilars, within B&H. Results: The availability of the mAbs in B&H appears satisfactory, which is encouraging. However, current usage is limited to a few mAbs which is a concern for subsequent patient care especially with limited use of biosimilars to address issues of affordability. We also see limited use of biosimilar insulin glargine. Conclusion The limited use of mAbs including biosimilars needs to be addressed in B&H to improve the future care of patients within finite resources. We will monitor these developments.

Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs

2010 ◽  
Vol 28 (27) ◽  
pp. 4149-4153 ◽  
Author(s):  
Scott R. Berry ◽  
Chaim M. Bell ◽  
Peter A. Ubel ◽  
William K. Evans ◽  
Eric Nadler ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Systems ◽  
The United States ◽  
Drug Costs ◽  
Cancer Drug ◽  
Cancer Drugs ◽  
Care Systems ◽  
Effective Treatments

Purpose Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy. Methods Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared. Results Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value. Conclusion Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.

Accounting for the Rising Caesarean Section Rate in Canada: What Are the Roles of Changing Needs, Practices, and Incentives?

2021 ◽  
Author(s):  
Michael Baker ◽  
Maripier Isabelle ◽  
Mark Stabile ◽  
Sara Allin
Keyword(s):  
Caesarean Section ◽  
Financial Incentives ◽  
Health Care Systems ◽  
Caesarean Section Rate ◽  
The United States ◽  
World Health ◽  
Strong Increase ◽  
Primary Determinant ◽  
Care Systems ◽  
Health Organization

In most high-income countries, including Canada, the share of births by Caesarean section (C‑section) has risen over the past decades to far exceed World Health Organization recommendations of the proportion justified on medical grounds (15 percent). Although unnecessary C-sections represent an important cost for health care systems, they are not associated with clear benefits for the mother and the child and can sometimes represent additional risks. Drawing on administrative records of nearly four million births in Canada, as well as macro data from the United States and Australia, we provide a comprehensive account of rising C-section rates. We explicitly consider the contributions of the main factors brought forward in the policy literature, including changing characteristics of mothers, births, and physicians as well as changing financial incentives for C-section deliveries. These factors account for at most one-half of the increase in C-section rates. The majority of the remaining increase in C-sections over the period 1994–2011 occurred in the early 2000s. We suggest that some event or shock in the early 2000s is likely the primary determinant of the recent strong increase in the C-section rate in Canada.

scholarly journals Assessing COVID-19 Risk, Vulnerability and Infection Prevalence in Communities

2020 ◽  
Author(s):  
Amin Kiaghadi ◽  
Hanadi S. Rifai ◽  
Winston Liaw
Keyword(s):  
Health Care Systems ◽  
Principal Component ◽  
The United States ◽  
Infection Prevalence ◽  
Planning Tool ◽  
Harris County ◽  
Census Tracts ◽  
Medical Interventions ◽  
County Population ◽  
Care Systems

AbstractBackgroundThe spread of coronavirus in the United States with nearly one million confirmed cases and over 53,000 deaths has strained public health and health care systems. While many have focused on clinical outcomes, less attention has been paid to vulnerability and risk of infection. In this study, we developed a planning tool that examines factors that affect vulnerability to COVID-19.MethodsAcross 46 variables, we defined five broad categories: 1) access to medical, 2) underlying health conditions, 3) environmental exposures, 4) vulnerability to natural disasters, and 5) sociodemographic, behavioral, and lifestyle factors. We also used reported rates for morbidity, hospitalization, and mortality in other regions to estimate risk at the county (Harris County) and census tract levels.AnalysisA principal component analysis was undertaken to reduce the dimensions. Then, to identify vulnerable census tracts, we conducted rank-based exceedance and K-means cluster analyses.ResultsOur study showed a total of 722,357 (~17% of the County population) people, including 171,403 between the ages of 45-65 (~4% of County’s population), and 76,719 seniors (~2% of County population), are at a higher risk based on the aforementioned categories. The exceedance and K-means cluster analysis demonstrated that census tracts in the northeastern, eastern, southeastern and northwestern regions of the county are at highest risk. The results of age-based estimations of hospitalization rates showed the western part of the County might be in greater need of hospital beds. However, cross-referencing the vulnerability model with the estimation of potential hospitalized patients showed that part of the County has the least access to medical facilities.ConclusionPolicy makers can use this planning tool to identify neighborhoods at high risk for becoming hot spots; efficiently match community resources with needs, and ensure that the most vulnerable have access to equipment, personnel, and medical interventions.

scholarly journals Identification and management of prediabetes: results of the Latin America Strategic Prediabetes Meeting

2017 ◽  
Vol 41 ◽  
pp. 1 ◽  
Author(s):  
Patricio López-Jaramillo ◽  
Ramfis E. Nieto-Martínez ◽  
Gestne Aure-Fariñez ◽  
Carlos O. Mendivil ◽  
Rodolfo A. Lahsen ◽  
...  
Keyword(s):  
Latin America ◽  
Health Care Systems ◽  
Public Health Problem ◽  
Preventive Treatment ◽  
Cost Effective ◽  
Lifestyle Changes ◽  
Diagnosis And Treatment ◽  
Effective Interventions ◽  
The Status ◽  
Care Systems

To understand the status of prediabetes diagnosis and treatment in Latin America and to evaluate the use of metformin for diabetes prevention in this context. A panel of 15 diabetes experts from seven countries in Latin America met on 14 – 15 August 2014 in Lima, Peru, to review the available literature, discuss the role of prediabetes in type 2 diabetes mellitus and cardiovascular disease, analyze collected information, and make conclusions for prediabetes diagnosis and treatment in Latin America. Prediabetes diagnosis, screening, and treatment, including lifestyle changes, pharmacological treatment, and cost-effectiveness were discussed. Five resulting statements were issued for Latin America: prediabetes is a clinical and public health problem; health care systems do not currently diagnose/treat prediabetes; use of prediabetes risk detection tools are needed region-wide; treatment includes lifestyle changes, multidisciplinary education, and metformin; and registries of patient records and further studies should be supported. The expert panel concluded that in Latin America, preventive treatment through lifestyle changes and metformin are cost-effective interventions. It is important to improve prediabetes identification and management at the primary care level.

scholarly journals A 2019. évi ARIA kezelési irányelvek magyar adaptációja és a hazai alkalmazás lehetőségei allergiás rhinitisben

2020 ◽  
Vol 161 (49) ◽  
pp. 2059-2071
Author(s):  
Helga Kraxner ◽  
Andor Hirschberg ◽  
Kristóf Nékám
Keyword(s):  
Health Care ◽  
Allergic Rhinitis ◽  
Mobile Health ◽  
Health Care Systems ◽  
Cost Effective ◽  
Allergic Diseases ◽  
The European Union ◽  
Sentinel Network ◽  
Intranasal Corticosteroids ◽  
Care Systems

Összefoglaló. Az allergiás betegségekben szenvedő emberek száma világszerte, köztük Magyarországon is növekszik. Az egészségügyi ellátórendszerek azon dolgoznak, hogy minél hatékonyabban tudják felhasználni a rendelkezésre álló forrásokat. Az Allergic Rhinitis and its Impact on Asthma (ARIA) szervezet célja az allergiás náthában szenvedő betegek ellátásának javítása, szakmai ajánlások készítése, aktualizálása. Ennek egyik módja integrált betegellátási utak kidolgozása. Célunk ezek hazai elérhetővé tétele, az ajánlások széles körű elterjesztése az Európai Unió (EU) többi tagállamához hasonlóan Magyarországon is. Az ARIA más nemzetközi innovatív szervezetek bevonásával olyan integrált betegellátási utakat fejlesztett ki, amelyek allergiás nátha, esetleg társbetegsége, az asztma esetén támogatják a kezelést. Ezeket újgenerációs irányelvek kidolgozása útján alkották, amelyekhez felhasználták a mobiltechnológiából és pollenkamra-vizsgálatokból származó valós evidenciákat is. A gyógyszeres terápia optimalizálásához a vizuális analóg skálán alapuló, úgynevezett Mobil Légúti Figyelő Hálózat algoritmusát digitalizálták, és valós evidenciák felhasználásával tovább finomították. Allergén immunterápiára az ARIA a világon elsőként dolgozott ki integrált betegellátási utakat 2019-ben. A kezelési irányelvekhez való adherenciaszint alacsony, a betegek a tüneteik erőssége alapján módosítják a kezelést. A flutikazon-propionát–azelasztin kombináció hatása erősebb az intranasalis kortikoszteroidokénál, míg az utóbbi hatásosabb az oralis H1-antihisztaminoknál. A mobiltelefonokban tárolt elektronikus napló vagy más ’mobile health’ (mHealth) eszközök használata segíti a betegek kiválasztását allergén immunterápiára. Az ARIA által javasolt algoritmus megfelelőnek mutatkozott az allergiás rhinitis kezelésére, ezért ezek az irányelvek bekerülnek integrált betegellátási utakba, és részét fogják képezni az EU Egészségügyi és Élelmiszer-biztonsági Főigazgatósága digitalizált, személyközpontú gondozási anyagainak. Az allergén immunterápia hatékony az inhalatív allergének által okozott allergiás betegségekben, alkalmazását azonban korlátozni kell gondosan válogatott betegekre. Orv Hetil. 2020; 161(49): 2059–2071. Summary. The number of allergic patients is increasing all over the world, also in Hungary. Delivering effective and cost-effective health care is essential for all health care systems. ARIA (Allergic Rhinitis and its Impact on Asthma) aims to improve the care of patients who suffer from allergic rhinitis by setting up guidelines and updating them. Development of ICPs (integrated care pathways) can play an essential role in attaining this goal. Our aim is to make ICP-s developed by ARIA available also in Hungary, as is already the case in other countries of the European Union (EU). Together with other international initiatives, ARIA has worked out digitally-enabled ICPs to support care in allergic rhinitis and comorbid asthma. ICPs are based on new-generation guidelines using RWE (real-world evidence) from chamber studies and mobile technology. The MASK (Mobile Airways Sentinel NetworK) algorithm – based on visual analogue scale – was digitalized to support pharmacotherapy, and was refined by using RWE. ARIA was the first to develop ICPs for allergen immunotherapy (AIT) in 2019. Based on MASK data, patients did not follow guidelines and their adherence to treatment was poor. Patients would modify their treatments, depending on the disease control. The effect of fluticasone propionate–azelastine combination is superior to intranasal corticosteroids which are superior to oral H1-antihistamines. Electronic diaries obtained from cell phones and other ’mobile health’ (mHealth) devices help select patients for AIT. The ARIA algorithm for AR was found appropriate and no change is necessary. These guidelines will inform ICPs and will be included in the DG Santé digitally-enabled, person-centred care system. AIT is an effective treatment for allergic diseases caused by inhaled allergens. Its use should, however, be restricted to carefully selected patients. Orv Hetil. 2020; 161(49): 2059–2071.

scholarly journals Η επίδραση του θεσμικού, πολιτικού και διοικητικού περιβάλλοντος στη μεταρρύθμιση του τομέα της υγείας στην Ελλάδα, 1950-2005

2013 ◽  
Author(s):  
Ηλίας Γορανίτης
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Health Care Systems ◽  
Implementation Process ◽  
The United States ◽  
International Experience ◽  
Health Care Reforms ◽  
Care Systems ◽  
Veto Points ◽  
Theories Of Change

The Greek NHS, thirty years after its establishment, faces important performance deficiencies. With an ongoing economic crisis placing a further burden, a call for national health care reform is urgent. This doctoral thesis drawing upon (a) political theories of change, (b) institutional, political and administrative developments in Greece as well as (c) international experience, aims to provide a framework, in terms of planning and implementation process, for health care reform in Greece. The existing order of things, in every public policy system, impedes change and forces policies along specific paths, the deviation from which to a new policy paradigm is extremely difficult. The Greek NHS has never deviated from this path indicating the existence of strong interest groups, institutions with high set-up cost and limited political willingness or ability for strategic approach to overcome the ‘veto points’ of the reform in the system. In this thesis the way forward in reforming fragmented and path-dependent health care systems like the Greek NHS has been identified. By addressing big questions such as: How the Greek NHS reached this low performing level? What are the ingredients of a well performing health care system? What factors impede or promote successful reforms? How health care reforms in systems with multiple ‘veto points’ should be implemented? Political science and international experience from Spain, Portugal, Italy, the Netherlands and the United States provide important insights to our study.

Complementary, Alternative, and Integrative Medicine

2019 ◽  
Author(s):  
Helene M. Langevin
Keyword(s):  
Alternative Medicine ◽  
Health Care Systems ◽  
Academic Research ◽  
The United States ◽  
Evidence Base ◽  
Potential Harm ◽  
Therapeutic Massage ◽  
Care Systems ◽  
Potential Benefits ◽  
Alternative Sources

Complementary and alternative medicine (CAM) refers to a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional or allopathic medicine. Common CAM practices (e.g., acupuncture, meditation, and therapeutic massage) are gradually becoming incorporated into conventional care in response to patients looking to alternative sources for information and advice about health matters and increased understanding of various CAM methods through evidence-based testing. However, although the claims of some methods are supported with academic research, well-founded concerns remain in many popularized CAM practices regarding the lack of evidence and placebo effects. It is thus imperative for physicians to be comfortable in discussing CAM-related topics with patients and be able to appropriately and informatively guide them in a way that harnesses potential benefits and avoids potential harm. In this review, the major CAM therapies in the United States are examined, including the settings in which they are being used, evidence base status, and efficacy of some of the most commonly used modalities.  This review contains 5 figures, 21 tables, and 123 references. Keywords: Alternative medicine, complementary medicine, acupuncture, homeopathy, osteopathy, chiropractic, massage therapy, naturopathy

Sign in / Sign up

Export Citation Format

Share Document